OP0044 DOES RHEUMATOID ARTHRITIS PATIENTS’ RISK OF OVERALL AND SITE SPECIFIC CANCER DIFFERS FROM THE GENERAL POPULATION? A NATIONAL CLAIMS DATABASE COHORT STUDY IN THE ERA OF BIOLOGICAL TREATMENTS
Authors: M. Beydon, S. Pinto, Y. De-Rycke, B. Fautrel, X. Mariette, R. Seror, F. Tubach
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Earlier studies, before the era of biologics, showed that rheumatoid arthritis (RA) patients were at higher risk of overall malignancies, with an excess relative risk of 28% compared to the general population. This risk is mostly carried by specific cancers such as lung cancer, lymphomas along with skin cancers. An update of cancer incidence is warranted in order to explore whether cancer risk has been modified in the era of biological and targeted DMARDs. <h3>Objectives</h3> To estimate the risk of cancer in patients with rheumatoid arthritis compared to the general population. <h3>Methods</h3> We conducted a nationwide population-based study within the French national claim database "Système National des Données de Santé" (SNDS) between January 1<sup>st</sup> 2010 and December 31<sup>st</sup> 2020. We estimated the age and sex-standardized incidence ratios (SIR) and [95% CI] of cancer (all sites, site specific and hematologic malignancies) of RA patients, with the French population as reference, by use of the French Network of Population-Based Cancer Registries (FRANCIM). SIR were estimated with Poisson regression models. <h3>Results</h3> During the study period, 257,075 patients met the eligibility criteria, who contributed to a total of 1,906,742 person-years for the main analysis. RA patients had an increased risk of overall malignancy (SIR 1.20 [1.17-1.23]), particularly lung (SIR 1.41 [1.36-1.46], bladder (SIR 2.38 [2.25-2.51]), ears-nose-throat (SIR 1.40 [1.31-1.50]), cervix (SIR 1.80 [1.62-2.01]), prostate (SIR 1.08 [1.04, 1.13]), melanoma (SIR 1.37 [1.29-1.46]) cancers, marginal zone (SIR 1.22 [1.06-1.42]), diffuse large b cell (SIR 1.79 [1.63-1.96]), and Hodgkin (SIR 2.68 [2.23-3.18]) lymphomas, and multiple myeloma (SIR 1.50 [1.36-1.65]). Of note, some cancers were less frequent than in the general population such as pancreatic cancer (SIR 0.90, [0.83-0.97]) as well as breast and uterine body cancers (SIR 0.91 [0.88-0.94] and SIR 0.77 [0.71-0.84] respectively). Subgroup analyses revealed that the risk of overall malignancy was significantly less increased in women (SIR 1.08 [1.06-1.10]) than in men (SIR 1.34 [1.31-1.36]) (between group difference p &lt; 0.001). Whereas, the risk of pancreatic cancer was only decreased in men but not in women (SIR 0.83 [0.75-0.91] vs SIR 1.04 [0.92-1.17] respectively, p &lt; 0.001). Full details are presented in the Figure 1 below. Overall risk of cancer was increased in patients treated with csDMARD (SIR 1.15 [1.13-1.17]), Tumor Necrosis Factor inhibitors (SIR 1.11, [1.07-1.15]), abatacept (SIR 1.27 [1.16-1.39]) and rituximab (SIR 1.43 [1.31-1.55]) versus the general population, however this association was not found in patients exposed to anti-IL6 (SIR 1.00 [0.90-1.10]) and Janus Kinase inhibitors (SIR 0.97 [0.77-1.21]). <h3>Conclusion</h3> In the era of biologics, RA patients remain at greater risk of overall malignancy and some site-specific cancers, not only lung cancer and lymphoma. This higher incidence of overall malignancy was observed in RA patients treated with almost all type of DMARD or bDMARD. However, no causal relationship between treatments and cancer incidence can be drawn as indication bias was not taken into account. Of note, we observed a lower incidence of breast, pancreatic and uterine body cancers than the general population. <h3>References</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.